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INTRODUCTION:

Peroneal tendinopathy (PT) is a condition that often causes pain around the outside of the ankle or foot. Is considered the inflammation of the peroneal muscles tendons, these muscles are fibularis longus, fibularis brevis and peroneus tertius. They allow the plantar flexion and eversion of the foot. These muscles play a role in the movements of the ankle joint and support of the foot. Additionally, the fibularis longus muscle provides support to the arches of the foot. Both muscles are innervated by the superficial fibular nerve (L5, S1), and receive their blood supply from branches of the anterior tibial and fibular arteries.

SYMPTOMS AND CAUSES:

We can have different symptoms related to PT e.g: ankle pain along the length of your tendon; pain that gets worse with physical activity; swelling, redness or warmth around your tendon; thickened tendons, with a mass or nodule that moves with your tendon; feeling unstable when walking and struggling with uneven surfaces; poor single leg balance on the affected side, the affected side will be worse than the unaffected and you may feel like you are always falling to the outside.

Peroneal tendonitis is common in running athletes, young dancers, ice skaters and sports requiring frequent change of direction or jumping such as basketball, skiing and even horse riding. Chronic lateral ankle instability and excessive subtalar and ankle varus rotation may cause damage to the peroneal tendons. Contributional factors for the development of peroneal tendonitis are tight calf muscles, inappropriate training, poor foot biomechanics such as over-pronation of the foot or excess eversion of the foot, inappropriate footwear and muscle weakness. Other causes include severe ankle sprains, repetitive or prolonged activity, direct trauma’s, chronic ankle instability, fractures of the ankle or calcaneus, and peroneal tubercle hypertrophy.

DIAGNOSIS AND TREATMENT:

Could be challenging to diagnose PT, in fact in most of the cases is misdiagnosed, because some of the symptoms can be confused with other foot pain or injuries, such as ankle sprain, fracture or arthritis. The assessment should be based on patient history and physical examination. Muscles tests that involve the peroneus muscles in eversion and plantar flexion, or palpation of the insertional areas of the peroneal muscles tendon are some of the most appropriate tests. MRI or X-ray could be necessary to exclude the presence of arthritis, fracture, or cartilage damages.

Physiotherapy could be beneficial to treat the PT in a conservative way. For example, the protocol PEACE and LOVE, in the acute phase (1). A good therapeutic programme exercise based on stretching, strength and proprioceptive exercises may also reduce the pain (2). Manual therapy such as mobilisation and manipulation of the joints involved and near could also be beneficial. Using comfortable shoes, insoles also could improve the condition. Ultrasound therapy, Tecar therapy and extracorporeal shock wave therapy (ESWT) are also used to treat PT.

Resources:

  1. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020 Jan;54(2):72-73.
  2. Schiffke-Juhász, B., Knobloch, K., Vogt, P.M. et al. Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis—a prospective trial. J Orthop Surg Res 16, 468 (2021). 

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